Provider Demographics
NPI:1952592560
Name:JIRON, R. VIVIAN
Entity Type:Individual
Prefix:DR
First Name:R. VIVIAN
Middle Name:
Last Name:JIRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 PIPILO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3577
Mailing Address - Country:US
Mailing Address - Phone:858-922-7484
Mailing Address - Fax:
Practice Address - Street 1:9325 PIPILO ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-3577
Practice Address - Country:US
Practice Address - Phone:858-922-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41033207Q00000X
NM85-215207Q00000X
TXG3497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine